Gingival Melanin Pigmentation Research Articles

Depigmentation: A Review

Melanin, carotene and hemoglobin are the most common natural pigments which contribute to the normal colour of the gingiva. The physiologic gingival pigmentation is not a medical problem, but complaints about “black gums” are common. Gingival depigmentation can be carried out using non-surgical and surgical procedures. Each technique has its own advantages and disadvantages. Selection of a technique is based on clinical experience and the individual's preferences. Removal of gingival melanin pigmentation should be performed with a caution and the adjacent teeth should be protected, as inappropriate application may cause gingival recession, damage to underlying periosteum and bone, delayed wound healing as well as loss of enamel.

Comparison of two different depigmentation techniques for treatment of hyperpigmented gingiva.

Introduction:Demand for cosmetic therapy of gingival melanin pigmentation is common. Re-pigmentation after gingival depigmentation is an important point. The aim of this study is to evaluate the effect of surgical scraping and electrosurgery on postoperative pain, healing and recurrence of pigmentation.Materials and Methods:Fifteen patients with esthetic concern related to black gums were selected and treated by surgical scraping with respect to right quadrant and electrosurgery with respect to left quadrant. Patients were recalled post-operatively to evaluate healing and recurrence of pigmentation. Each patient was asked to complete the Visual Analogue Scale (VAS) index cards 2 and 24 hours postoperatively.Results:In the initial post-operative period, VAS index cards showed that the discomfort and pain level associated with electrosurgery was significantly higher than conventional scalpel surgery (P < 0.05). Clinically delayed healing was observed in the electrosurgically treated site. Electrosurgery showed better results as compared to epithelial excision for recurrence of pigments. At the end of 15 months, 7 sites in the scalpel excision group showed recurrence, whereas only 4 site showed recurrence in the electrosurgically treated group.Conclusion:The methods used here produced desired results and above all, the patients were satisfied with the outcome. Increased pain level and clinically delayed healing was associated with electrosurgery as compared to scalpel surgery, whereas repigmentation occurred more frequently in scalpel-treated sites.

Evaluation of gingival pigmentation in children exposed to and not exposed to environmental tobacco smoking

Background and Aim: The exposure to environmental tobacco smoke (ETS) has been recognized as a strong contributor to respiratory disorders, lung cancer, peripheral vascular function and death. Increased gingival pigmentation in smokers is established. In children exposed to ETS, an increased incidence of caries and pigmentation of gingiva were documented. In a country like India where no stringent smoke-free policies exist and the presence of joint family systems in rural population, children are at a greater health risk when either one of the family member is a smoker. The potential accumulation in melanin-containing tissues of nicotine and tobacco-specific compounds may be a concern for any individual who is chronically exposed to tobacco smoke. Gingival pigmentation is easy to assess and could be of significant importance while educating parents in terms of their child's health. Thus primary objective of our study is to assess the effects of ETS on gingival pigmentation in children with ≥1 smoker parent or close relatives. Materials and Methods: A total of 228 students between the age group of 6-16 years were selected randomly. The cases included children exposed to ETS who were non-smokers and the controls were not exposed to ETS at home. Pigmentation was assessed using Dummet & Co's pigmentation index and smoking was assessed by interview. Results: The prevalence of pigmentation in subjects not exposed to ETS was found to be 132 (80.5%) subjects in comparison to 32 (19.5%) without any gingival pigmentation. It can also be noted that all the 64 (100%) subjects exposed to ETS had pigmented gingiva. Conclusion: Within the limitations of this cross-sectional observational study, we conclude that there may be a correlation between gingival melanin pigmentation of children exposed to ETS.

Impact of Various Effects of Smoking in the Mouth on Motivating Dental Patients to Quit Smoking

We explored the impact of addressing personally relevant effects of smoking in the mouth on promoting the motivation to quit in a dental setting at personal and public levels. Stages of behavior change and attempts to quit smoking by smokers were recorded during dental visits. Dentists selected and gave motivational information from 24 topics relevant to a patient’s oral health status, risk, or dental treatment. During the dental visit, each topic was presented to patients. Topics of gingival melanin pigmentation and periodontal disease risk were most frequently presented. Progression through stages of behavior change and attempts to quit smoking were observed after presentation of each topic. At a personal level, progression through stages was most frequently observed after the patient was shown an image of pediatric dental caries and smoker’s palate, and attempts to quit was most frequently observed after the patient shown an image of the effects of smoking cessation and pediatric dental caries. At the public level, enhancing the motivation to progress through stages and attempts to quit was most frequently observed after the presentation of effects of smoking cessation and discoloration of teeth, although the intensity of enhanced motivation significantly correlated with the frequency of presentation, which was not the highest for these topics. Although various smoking effects on the mouth have potential impact on promoting the motivation to quit, the impact on enhancing motivation is not necessarily consistent at personal and public levels.

Effectiveness of Cryogen Tetrfluoroethane on Elimination of Gingival Epithelium and its Clinical Application in Gingival Depigmentation– Histological Findings and Case Series

To histologically assess and clinically co-relate the effectiveness of cryogen Tetrafluoroethane (TFE) for gingival depigmentation procedure. Twelve patients having unaesthetic gingival melanin pigmentation were included in the study. Gingival tissues of eight patients having gingival melanin pigmentation undergoing gingivoplasty or gingivectomy for crownlengthening were exposed to the cryogen and this was used for the histological examination. Gingivectomies were done after 8, 24, 96 hours and after a week of application of tetrafluoroethane. Four fair skinned patients complaining of unaesthetic gingival hyperpigmentation underwent gingival depigmentation using Tetrafluoroethane cryogen. Histologically after 96 hours of application of cryogen there was complete loss of retepegs and epithelial detachment from the corium was evident. Complete re - epithelialisation was noted after a week and was clinically correlated. We therefore, concluded that histologically tetrafluoroethane can effectively destroy gingival epithelium without causing damage to the connective tissue and clinically the color of the gingiva had more pleasing appearance 6 months postoperatively. Hence the cryogen can be used safely for depigmentation procedure.

Diode Laser: An Ideal Option for Treatment of Gingival Hyperpigmentation

ABSTRACT Gingival hyperpigmentation are major concerns for a large number of patients visiting the dentist. Melanin hyperpigmentation usually does not present a medical problem, but patients usually complain of dark gums as unesthetic. Pigmentation of gingiva is commonly caused by deposition of melanin in the basal layer of oral epithelium. Gingival melanin pigmentation may be seen across all the races and at any age without gender predilection. This case report describes the application of semi conductor diode laser procedure for gingival depigmentation. How to cite this article Saini R, Pazinatto FB, Radnai M. Diode Laser: An Ideal Option for Treatment of Gingival Hyperpigmentation. Int J Experiment Dent Sci 2013;2(2): 139-140.

Cryosurgery by tetrafluoroethane: An answer to black gums

To highlight the effect of 1,1,1,2 tetrafluoroethane (TFE), a new material for cryosurgery of gingival melanin pigmentation (GMP). Five patients were treated using a TFE-cooled swab and the pre- and post-treatment photographs were compared. Complete keratinization took place in 3-4 weeks after application without any trace of pigmentation. During the follow-up period, no side effects were observed and the improved esthetics were maintained upto 1 year.

The correlation of skin color and gingival pigmentation patterns in a group of South Indians in Tamil Nadu, India

Background: Melanin pigmentation of the gingiva occurs in all ethnicities. Excessive pigmentation is an esthetic concern that has increased awareness about depigmentation procedures. The purpose of the present study is to correlate skin color and gender with intensity and distribution of gingival melanin pigmentation in a group of South Indians for treatment strategies. Materials and Methods: A total of 200 male and female non-smoking healthy subjects were included aged 18-35 years. A clinical examination of gingiva was performed to assess the anatomic distribution of gingival pigmentation. The intensity of gingival pigmentation and phenotype of gingiva were also assessed. Subsequently, the skin color was visually examined and assessed as fair, wheatish brown and dark. Results: Six classes of gingival pigmentation were defined based on the anatomic distribution. Gingival pigmentation was observed as highest being in the attached gingiva and interdental papilla (25.4%) and least being in the marginal gingiva and interdental papilla (10.2%). Correlation between skin color and intensity of pigmentation was statistically significant, with dark skinned subjects having heavy gingival pigmentation. However, no correlation was found between gender and phenotype of the gingiva with intensity and distribution of pigmentation. Conclusion: South Indians predominantly have pigmentation in attached gingiva and interdental papilla and their skin color is positively correlated with the intensity of pigmentation. Incidence of pigmentation did not differ between the sexes. Majority of subjects had thick gingival phenotype. Anatomic delineation of gingival pigmentation and their contributory factors may help design treatment strategies in depigmentation procedures.

A comparison of diode laser and Er:YAG lasers in the treatment of gingival melanin pigmentation

This study compared the use of diode and Er:YAG lasers in treating gingival melanin pigmentation (GMP) in terms of gingival depigmentation, local anesthesia requirements, postoperative pain/discomfort, depigmentation effectiveness, and total treatment duration. Twenty patients (13 female, 7 male) referred with GMP were enrolled in the study. Patients were randomly divided into 2 groups. Group 1 was treated with a gallium aluminum arsenide diode laser with a continuous wavelength of 808 nm, and group 2 was treated with an Er:YAG laser with a continuous wavelength of 2,940 nm. Gingival depigmentation was performed by applying the laser at 1 W. Treatment was administered on a weekly basis until a normal pink gingival color was observable in clinical examination and photographs. In addition, patients were asked to evaluate the procedure by using a self-administered questionnaire. Procedures were carried out without the need for any topical or local anesthetic, and no unpleasant events occurred during the actual procedure or the healing period. The total length of treatment was significantly shorter with the diode laser (group 1) than with the Er:YAG laser (group 2; P < .05). No melanin recurrence was detected during any follow-up session. Diode and Er:YAG lasers administered at 1 W both result in satisfactory depigmentation of GMP.

Treatment of gingival hyperpigmentation with rotary abrasive, scalpel, and laser techniques: A case series

Melanin pigmentation often occurs in the gingiva as a result of an abnormal deposition of melanin, due to which the gums may appear black, but the principles, techniques, and management of the problems associated with gingival melanin pigmentation are still not fully established. Depigmentation procedures such as scalpel surgery, gingivectomy with free gingival autografting, electrosurgery, cryosurgery, chemical agents such as 90% phenol and 95% alcohol, abrasion with diamond bur, Nd: YAG laser, semiconductor diode laser, and CO2 laser have been employed for removal of melanin hyper pigmentation. The following case series describes three different surgical depigmentation techniques: scalpel surgery, abrasion with rotary abrasive, and a diode laser. Better results of depigmentation were achieved with diode laser than conventional scalpel and with rotary abrasion with respect to esthetics. The results point out that lasers are an effective and a safe means to removal of hyperpigmentation from the gingiva. Healing was uneventful and no repigmentation occurred.

Gingival depigmentation by surgical treatment

In dentistry, esthetics is a great concern both for the patient and operator. The aim of this clinical article is to review the methods of depigmentation of melanin pigmentation of gingiva and explain scalpel surgical technique for depigmentation of gingiva. Gingival pigmentation occurs in all races of mankind. The degree of melanin pigmentation may vary from person to person. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with a challenge of achieving gingival esthetics. This article presents a simple surgical technique of de-epithelization which has been successfully used to treat gingival hyperpigmentation caused by excessive melanin deposition.

Gingival depigmentation: Clinical comparison between two techniques

Gingival melanin pigmentation occurs in all human races. Although clinical melanin pigmentation presents a major esthetic concern for many people, it does not pose a medical problem nor is it any disease entity. Esthetic gingival depigmentation procedures can be performed in these patients, with excellent results. This article presents a de-epithelization procedure using popular surgical techniques such as the scalpel and the other with bur abrasion. These techniques were successfully used to treat gingival hyperpigmentation. Although it was found that bur abrasion increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction.

Ablation of gingival melanin pigmentation with Nd:YAG laser

Ablation of gingival melanin pigmentation with Nd:YAG laser

Gingival Depigmentation using the Diode Laser: Three Case Reports

Melanin pigmentation of the gingiva is a common occurrence. Depending on the gingival display during smiling, corrective measures may be needed for an esthetic purpose. Diode laser is a minimally invasive treatment option for the treatment of gingival melanin pigmentation. Three case reports of gingival depigmentation procedure performed using a 980 nm diode laser are presented here.

Effect of Environmental Tobacco Smoke From Smoker Parents on Gingival Pigmentation in Children and Young Adults: A Cross‐Sectional Study

Non-smokers exposed to environmental tobacco smoke (ETS) absorb nicotine and other compounds just as smokers do, and as the exposure to ETS increases, the level of these harmful compounds in the body also increases. The ill effects of ETS range from gingival pigmentation to lung cancer and death. The exposure to ETS is difficult to quantitatively measure and has been approximated by self-reported estimates, primarily of the smoking history of spouses. However, the documentation of gingival pigmentation in non-smokers is meager and has remained contentious. We aimed to assess the effects of ETS from smoker parents on gingival pigmentation in children and young adults and assess the urine cotinine levels in these individuals. A total of 153 non-smoking participants with ≥1 smoker parent were randomly selected from the outpatient Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate Research Center, Bangalore, India. These participants were divided into three groups based on age, and the smoking history of parents was established by an interview with participants and parents. The degree of gingival pigmentation of participants was assessed by using the gingival pigmentation index and a standardized digital oral photograph. A urine analysis was conducted to assess levels of cotinine. The κ statistic was performed for interexaminer agreement, and χ(2) and Fisher exact tests were used for statistical analyses. The prevalence of gingival pigmentation in passive smokers was statistically significant (P <0.05). Increased levels of urinary cotinine were observed in all three groups with the highest levels in group 3 (19 to 24 years old). This study depicts the effects of ETS on gingival melanin pigmentation.

Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature

Gingival melanin pigmentation occurs in all races of mankind. Although clinical melanin pigmentation does neither present itself as a medical problem nor a disease entity, it is a major esthetic concern for many people, especially Asians. Esthetic gingival depigmentation procedures can be performed in such patients with excellent results. This case series presents a split mouth de-epithelization procedure using popular surgical techniques such as scalpel, bur abrasion or electrosurgery. These techniques were successfully used to treat gingival hyperpigmentation. Although we found that electrosurgery increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction. However, the cases are being followed-up to study the factors affecting the rate and length of time required for repigmentation and to study the repigmentation patterns. This case series also reviews the advantages and disadvantages of various techniques available for depigmentation, and reiterates that the scalpel technique still serves as a gold standard for depigmentation.

Duration of reappearance of gingival melanin pigmentation after surgical removal - A clinical study.

Background:In dentistry, esthetics has a special place. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with a challenge of achieving gingival esthetics.Materials and Methods:A method of de-epithelialization of the pigmented gingiva using Kirkland’s gingivectomy knife is described. Twenty patients who were conscious about their gingival melanin pigmentation were selected. The gingiva of the whole of the arch was abraded until the entire visible pigmentation was removed. Clinical observations for intensity of pigmentation were recorded at baseline and then after surgery at monthly intervals over a period of 9 months according to Dummett-Gupta Oral Pigmentation Index scoring criteria proposed by Dummett C. O. in 1964.Results:The mean gingival melanin pigmentation score came down to 0.407 after 9 months as compared to preoperative score, which was 2.24. No repigmentation occurred in fair-complexioned persons. In persons with wheatish complexion, repigmentation was seen in 85.71% of the cases, but scores came down to 0.38 postoperatively as compared to 2.27 preoperatively. In dark-complexioned persons, repigmentation occurred in all cases, but the mean scores were 0.93 as compared to 2.40 preoperatively. The difference between preoperative and postoperative mean scores for each segment was put to statistical analysis by applying paired t test and was found to be significant.Conclusion:As this method has shown statistically significant results, it can be used in patients who are conscious of pigmented gingiva and want an esthetically satisfactory color.

Effects of Ascorbic Acid on Gingival Melanin Pigmentation In Vitro and In Vivo

Gingival melanin pigmentation may cause esthetic concerns, even if no serious medical problem is present. As an inhibitor of melanin formation, ascorbic acid is often used to treat skin melanin pigmentation. Thus, the present study investigated the effects of ascorbic acid on gingival melanin pigmentation in vitro and in vivo. The effects of ascorbic acid on melanin formation were evaluated in vitro in B16 mouse melanoma cells and three-dimensional human skin models. In addition, a clinical trial was performed to investigate the inhibitory effects of a gel containing ascorbic acid 2-glucoside (AS-G gel) on gingival melanin pigmentation. This study used a double-masked, split-mouth design on 73 subjects with symmetric gingival melanin pigmentation. AS-G gel was applied to one side of the gingiva for 12 weeks, whereas placebo gel was applied to the other side as a control. Luminance (L*)-value, which describes the lightness of gingiva, was determined by spectrophotometry to obtain an objective measure of melanin pigmentation every 4 weeks. Ascorbic acid significantly inhibited tyrosinase activity and melanin formation in B16 mouse melanoma cells (P <0.01 and P <0.05, respectively). The inhibitory effects of ascorbic acid on melanin formation were also significant in three-dimensional human skin models (P <0.01). Moreover, in the clinical trial, a significant relative change in pigmentation was seen after 4 weeks with the application of AS-G gel compared to placebo (L*-value ratio). Ascorbic acid (AS-G) has potential for the treatment of gingival melanin pigmentation.

Phenol peel therapy for oral leukoplakia: report of three cases

Chemical peeling is a treatment method that destroys the epidermis and/or dermis with subsequent regeneration of new epidermis and dermis using a peeling agent. Phenol is one peeling agent that has been extremely effective in obtaining a complete response for gingival leukoplakia. In this report, we describe three cases of gingival leukoplakia that were treated with phenol peel, and we discuss the effects and applicable cases. All patients consulted our hospital in 2003 and refused surgical treatment, including laser surgery, so we performed chemical peeling using a phenolalcohol method that was previously reported for gingival melanin pigmentation. All cases achieved a complete response without local anesthesia or hospitalization. No patient felt pain at the time of application or post-treatment. None of the cases had a local recurrence or malignant transformation for approximately 69 months after the application of phenol peel. The use of a phenol peel may also be indicated for leukoplakia with dysplasia or other epithelial lesions. However, additional clinical studies that closely follow treated patients and further basic studies are still needed.

Esthetic Treatment of Gingival Melanin Hyperpigmentation With Er:YAG Laser: Short‐Term Clinical Observations and Patient Follow‐Up

Recently, the erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser has been applied effectively for periodontal soft tissue management. The purpose of this study was to report removal of gingival melanin pigmentation using an Er:YAG laser in a short-term clinical observation. Five patients with gingival melanin pigmentation participated in this study. Irradiation was performed at 64.0 mJ/pulse (8.5 J/cm2 per pulse) and 10 Hz under water spray in contact mode. Clinical parameters, such as bleeding, swelling, redness, and healing, were evaluated immediately after the surgery and 24 hours, 1 and 4 weeks, and 3 months later. A visual analog scale was used to evaluate the pain level experienced. The Er:YAG laser effectively ablated the epithelial tissue containing melanin pigmentation. At 1 week, gingiva showed fast epithelization with a healthy appearance in all cases. At 2 weeks, gingiva showed satisfactory healing with significant improvement in color and recovery of the tissue thickness. At 1 month, complete healing was observed; after the 3-month evaluation, no gingival deformity or recession was observed. However, there was a slight recurrence in one case. Removal of gingival melanin pigmentation can be performed safely by Er:YAG laser resulting in an esthetically significant improvement of gingival discoloration.